Social participation after community stroke rehabilitation: individual and intervention factors in a retrospective cohort study

Improving social participation is a key objective of poststroke rehabilitation, yet determinants of successful outcomes in Community Stroke Rehabilitation Teams (CSRT) remain poorly understood. In particular, the respective contributions of person-related and intervention-related factors need clarification.

To identify person-related and intervention-related factors associated with improvement in social participation following a home-based CSRT rehabilitation program.

We conducted a retrospective cohort study including 534 patients with stroke managed by a CSRT between 2019 and 2024. Social participation was assessed using the Frenchay Activities Index (FAI) at baseline and after intervention. Responders were defined as a FAI score increase ≥7 points. Multivariable logistic regression analyses were performed to identify independent predictors among patient characteristics and intervention components.

Seventeen percent of participants achieved an improvement in FAI ≥7 points. Independent person-related factors included younger age (OR 0.975; P = 0.010) and higher baseline functional status (Barthel Index) (OR 1.027; P = 0.005). Regarding intervention-related factors, programs including adapted physical activity (OR 2.01; P = 0.023), mobility-focused interventions (OR 3.21; P = 0.043), communication (OR 2.15; P = 0.035), and work reintegration support (OR 2.17; P = 0.015) were significantly associated with FAI improvement. Participation in therapeutic education workshops was more frequent among Responders (88%vs 60%, P < 0.001), particularly those focused on adapted physical activity, mobility retraining, and communication. Responders also showed greater improvement in quality of life.

Personal and stroke-related factors show limited ability to predict improvement in social participation. In contrast, key interventions targeting mobility, physical activity, communication, and work reintegration are significantly associated with an improvement in social participation.

This study was a retrospective observational study based on routine clinical care and was not prospectively registered in an international trial registry.